by Diana Zuckerman, PhD, president of the National Research Center for Women & Families
Do laws in Texas, Virginia, and Alabama requiring women's health clinics to provide hospital-type surgical facilities show how much these states' legislators care about women's health, as Texas' Governor Perry and others have claimed? Or is the goal to limit women's access to safe abortions, as Wendy Davis and many others have suggested? Whatever the reason, these laws, cloned from state to state, will result in few, if any, safe options for women seeking family planning services, screening, and other services, in addition to abortions.
If these legislators really want to help women, I hope they will take advantage of an opportunity to protect many more women, including many of their friends and loved ones, from far more dangerous medical procedures. While approximately 1 in 1 million women who undergo abortions during the first eight weeks of pregnancy die from the procedure, 1 in 50,000 women are dying from other, more popular elective procedures in clinics and doctors' offices: cosmetic surgery. These cosmetic surgery patients are at 20 times the risk of death, and they need protection, too.
Every year, clinics perform cosmetic surgery on approximately 1.4 million women and 200,000 men, and perform an additional 13 million "minimally invasive" cosmetic procedures, such as facial injections to make wrinkles disappear and chemical peels intended to make skin look better.
As you can see, the numbers are staggering, compared to approximately 1 million abortions, many of which involve pills rather than surgery. Physicians tell us that abortion and cosmetic surgery are usually simple and safe procedures, but of course undergoing surgery always presents some risk. Cosmetic surgeons estimate that the invasive procedures and anesthesia involved in their procedures result in a death rate of 1 in 50,000 outpatient procedures. This translates to approximately 100 cosmetic surgery-related deaths per year. In contrast, many abortions rely on pills instead of surgery, making them much safer, with approximately 12 women dying from complications of an abortion in a typical year, according to the Centers for Disease Control and Prevention.
Women who have abortions later in their pregnancies have a death rate higher than 1 in 1 million--approximately 1 per 29,000 during weeks 16 to 20 of pregnancy. While this is tragic, later-term abortions still have a better safety record than pregnancy and childbirth, which is fatal for 1 in 7,700 American women each year. And both are safer than liposuction, which is a fatal procedure for 1 in 5,000 women each year.
Given the higher death rate from cosmetic surgery and the much larger number of women undergoing cosmetic surgeries and procedures, why is it that the legislators in Texas, Virginia, Alabama, Mississippi, North Dakota, and so many other states are so concerned about the safety of abortion clinics? According to abort73.com, an antiabortion website, there are fewer than 2,000 abortion providers in the entire country. This number compares to over 5,000 board-certified plastic surgeons, and thousands more men and women who perform cosmetic surgery but are not trained as plastic surgeons. (Here's something for legislators to consider: Any doctor or dentist in the U.S. can call him- or herself a plastic surgeon and perform surgery on any patient, without telling the patient that he or she was not trained as a surgeon.)
Last year, a plastic surgeon in Michigan wrote about the "Wild West" of plastic surgery, explaining that since plastic surgery is a lucrative business, "an increasing number of doctors are closing their traditional medical practices and opening cosmetic surgery centers. These physicians learn the basics of plastic surgery through weekend courses, shadowing other doctors and even online webinars." He explained that their procedures are performed in doctors' "in-office operating rooms or at ambulatory surgery centers, where the credentialing requirements may not be as strict." He concluded that "this influx of poorly trained cosmetic surgeons" has resulted in terrible cosmetic outcomes such as women with breast implants in their armpits and one woman with "shark-bite-sized divots all over her thighs and stomach after undergoing laser liposuction."
The plastic surgeon who was criticizing other plastic surgeons was talking about bad cosmetic outcomes. He didn't mention the death rates.
Regulations can protect our health, but they need to make sense. Requiring hospital-style facilities for early abortions and not for cosmetic surgery just doesn't. I think the comparison between abortion clinics and cosmetic surgery spas and clinics is enlightening, so our nonprofit center is providing it for free to legislators across the country. It would seem hypocritical for the Texas legislators not to do something about this, as Texas women undergo many more cosmetic surgeries and procedures than women in almost any other state. I've been advised, however, that I need to go in person and stand around for 13 hours or so in a pair of pink Mizuno running shoes to get their attention.
Perhaps what's going on in Texas and these other states has much more to do with women's reproductive body parts than it does with women's health. Even so, I believe that legislators can be persuaded to consider facts before they legislate. Perhaps I will follow the advice of a reviewer of Mizuno running shoes on Amazon.com: I will ask myself WWWD? Then I will stand up (without leaning on anything or changing the subject) for what I think is right.
Diana Zuckerman is the president of the National Research Center for Women & Families. She received her PhD in psychology from Ohio State University and was a post-doctoral fellow in epidemiology and public health at Yale Medical School. After serving on the faculty of Vassar and Yale and as a researcher at Harvard, Dr. Zuckerman spent a dozen years as a health policy expert in the U.S. Congress and a senior policy adviser in the Clinton White House. She is the author of five books, several book chapters, and dozens of articles in medical and academic journals as well as in newspapers across the country.
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